Plasmodium Falciparum associated Rhabdomyolysis

Abstract

Rhabdomyolysis-induced acute kidney injury (AKI) is highly unusual in P. falciparum-infected patients. Only a handful of cases have been described in the form of case reports, and the clear pathophysiology behind malaria producing the rhabdomyolysis is unclear. A 55-year-old man with a past medical history of 12 years of alcohol abuse presented to the Emergency Department with a 5-day history of on and off fevers and a 1-day history of pain in the abdomen, vomiting, and shortness of breath. Following initial investigations, the patient was found positive for Plasmodium falciparum infection. The patient was treated with intravenous (IV) artesunate, and on day-2 of admission, the patient developed anuria, severe respiratory distress, and bradycardia and had to be intubated and upgraded to intensive level care; further evaluation revealed elevated serum creatinine and myoglobinuria and diagnosis of secondary rhabdomyolysis and AKI. He was managed with forced alkaline diuresis, and a urine output higher than 200ml/hour was maintained with IV fluids. The patient consequently also developed symptoms of alcohol withdrawal, and lorazepam was added for management. On days 5-6 of admission, his symptoms started to improve, and his serum markers of rhabdomyolysis and AKI normalized. The patient was extubated, discharged, remains in follow-up, and has no residual sequelae due to this episode of illness.